Phone numbers and websites of all carriers is available by scrolling all the way to the bottom of this page.
A printable list is available by clicking here.
BENEFITS GUIDE
Info on all plans in one place!
Introducing the SJECCD Benefits Guide Book! Please click the link below for information on the District’s health and welfare package. Feel free to download a copy (.pdf) or save the link onto your own computer, as well as share the link with your spouse or child away at college. Information on all plans and added benefits is now available in one source, right at your fingertips 24/7.
Whether you are a new hire or you've been with the District for years, this book contains information on District plans all in one place!
OPPOSITE SEX DOMESTIC PARTNERS NOW ELIGIBLE:
As of October 1, 2020, those of you with an opposite sex domestic partner that are registered with the State of California as Domestic Partners may now enroll your partner under the District’s plan(s). If you are not already registered, you may do so by clicking here https://www.sos.ca.gov/registries/domestic-partners-registry/. Simply provide a completed SISC III Member Change Form and a copy of your certificate of registry within 30 days of becoming registered or you may have to wait until the 2021 OE period unless they have a qualifying event.
ADDITIONAL INFORMATION ON BLUE CROSS & KAISER
Anthem Blue Cross
Kaiser Permanente
ELECTRONIC SIGNATURES TEMPORARILY PERMITTED
Due to COVID, this year, hard copies are may not be readily available, therefore electronic signatures will be accepted on enrollment and change forms. You may also request electronic enrollment forms to be sent to you directly by emailing HR.Benefits@sjeccd.edu or calling 408.223.6713.
SENDING PROTECTED INFORMATION THROUGH EMAIL:
If you have an enrollment form or change form to submit to the Benefits Office, please send it through Office 365 and "Encrypt" the email prior to sending it. This will ensure protected information like dates of birth and social security numbers are sent securely. It is very simple just a click of a link but if you do not have access to that function, simply email HR.Benefits@sjeccd.edu and request an encrypted email to reply to.
Adjunct Faculty - Kaiser Permanente Plan:
The Adjunct enrollment period for the District's Kaiser Plan ended on September 24, 2021. However, if your load increases to 40% or higher mid-year, or you didn't enroll in the District's plan because you had other coverage and you lose that other coverage, contact HR.Benefits@sjeccd.edu immediately for possible enrollment options.
We find ourselves in unprecedented times. And although many of us won't get sick from this virus, it doesn't mean that these are any less stressful times. Fear and anxiety are real, natural emotions. For those of us (including anyone in our households) that would benefit from speaking to a professional to help us navigate through this pandemic, please see the flyer below for tips on managing those emotions as well as direction on how to get FREE counseling services.
COVID-19/Coronavirus Flyer
For more information on what our Employee Assistance Program (EAP) provides, please scroll below to the Employee Assistance section.
ELECTRONIC SIGNATURES TEMPORARILY PERMITTED
Due to COVID, this year, hard copies are may not be readily available, and many employees working remotely do not have the ability to print and/or scan from home. As a result, if you need to add or remove a dependent during this shelter at home, please download and save the Member Change Form below, SIGN it using AdobeSign, and route it to HR.Benefits@sjeccd.edu. If sending via regular email, do not include your social security number(s) unless sending through a secure email.
Working remotely is new to most of us. Many of us have found ourselves converting our kitchen, dining, or coffee tables into work spaces, or have added a new desk and converted regular living space into a daily workspace. Just as important as it was to you to make sure your workspace in your department was set up properly, the equipment you are using at home needs to be set up properly too. The best way to reduce fatigue, burn out, and ultimately injury is for you to set up the tools/equipment you have, in the best way possible for you. The following flyers will help you do that.
Think Ergonomics (desktop) - Helpful tips to help you customize your workstation when using a desktop computer.
Think Ergonomics (laptop) - Helpful tips to help you customize your workstation when using a laptop computer.
Sit/Stand Workstation - Helpful tips to assure your sit/stand device is adjusted and used properly.
Easy Ergonomics - a helpful guide put out by Cal OSHA to help you learn how to work safely and reduce your risk of injury.
Please channel any requests you may have for special or different equipment through your immediate supervisor. If you need special assistance, feel free to email Benefits Coordinator Michelle McKay at michelle.mckay@sjeccd.edu.
For those of you eligible for health and welfare benefits, please review the Benefits Guide Book for information on all the benefit plans (including optional benefits) available to you. Enrollment forms will be sent to you prior to your benefit orientation. Additional details on each plan can be found by scrolling down this page and will be discussed during your New Employee Orientation.
Benefits Guide (flip) Book
Dependent Eligibility List
Medical Plans
Anthem Blue Cross (Enrollment Packet for ALL benefit eligible Active employees)
Active Employee's Plan Summary including Prescription Coverage (Anthem Blue Cross)
Active Employee's Enrollment Guidebook (Anthem Blue Cross)
Costco Mail Order Prescription Form (Anthem Blue Cross Enrollees Only)
Anthem Mobile App Instructions
Anthem Hip, Knee & Spine Surgeries (Blue Distinction REQUIREMENTS)
SISC III Enrollment Form (Anthem Blue Cross) to print and sign
SISC III Enrollment Form (Anthem Blue Cross) for digital signatures
SISC III Membership Change Form (to add/terminate dependents, update address/name) to print and sign
SISC III Membership Change Form (for digital signatures)
Anthem In-Network Labs (SISC)
How to Print a Temporary ID Card (Anthem Blue Cross only)
Kaiser Permanente (Enrollment Packet for ALL benefit eligible employees including Adjunct Faculty)
Kaiser Enrollment Form (for digital signatures)
Active Employee's Plan Summary (Kaiser)
Kaiser Active Plan Summary (Spanish)
Active Employee's Enrollment Guidebook (Kaiser)
Chiropractic & Acupuncture Benefits (NEW)
Dental Plan
There is no annual cap for basic services and tiered. Basic Services are covered at 70% (first year), then each year you use the plan your coverage increases until you hit 100%. Orthodontia is covered at 100% up to a lifetime maximum of $3,000. Bridges and dentures however are covered at 50%. Below is a plan summary. Seeing a dentist that is part of Delta's PPO Network will provide you with the least out of pocket expense.
Delta Dental Plan Summary (eff 10/01/2018)
Vision Plan
VSP is our vision plan. You get one comprehensive exam every 12 months, glasses or contact lenses every 24 months. There is little to no out of network coverage so be sure you find a provider at www.vsp.com
VSP Plan Summary (effective 10/01/2018)
VSP TruHearing Hearing Aid Discount Program
Employee Assistance Plan (EAP)
AnthemEAP plans offer confidential counseling services to all our benefit eligible employees and covered retirees, their dependents and anyone living in the employee/covered retiree's household. Telephonic, electronic (like Facetime or Skype), and in person counseling services are available, as are legal services, financial planning services, child care assistance, elder care assistance, discounted tickets for movies and attractions, etc., as are resources for tobacco, alcohol and drug dependency and our over all emotional health and mental wellness.
EAP Overview
AnthemEAP Pamphlet
Old EAP (MHN) vs New EAP (Anthem) Comparison Chart
Child Care Resources
Elder Care Resources
Depression Resources Flyer
LiveHealth Online Flyer
myStrength Flyer
Identity Theft Flyer
Legal & Financial Services Flyer
Substance Abuse Flyer
Work-Life Flyer
Documents Accepted to Prove Dependent Eligibility for all plans (eff 7/1/2018)
Dependent Eligibility Chart
Anthem Blue Cross -
Retiree Plan Summary (For all Covered Retirees eff 7/1/2018)
EAP Plan (See EAP section above for more information on benefits/services available)
Kaiser Permanente -
Early Retiree Plan Summary (<65)
EAP Plan (information for those <65)
Senior Advantage Plan Summary (Retirees 65+)
Kaiser Senior Advantage Enrollment Form (for All Kaiser Enrollees >65)
Silver & Fit Flyer For Kaiser Senior Advantage Enrollees Only
AnthemEAP for Kaiser Senior Advantage Enrollees Only
To change your address, name, add/remove a dependent please print, complete, sign and return the form below to
HR.Benefits@sjeccd.edu, fax to 408.239.8804, or mail it via the Pony or US Mail to
Michelle McKay, Human Resources, 40 South Market Street San Jose, CA 95113.
SISC III Member Change Form
Adding Dependents:
Adding an eligible dependent that is not currently covered under your medical, dental and/or vision plan requires a completed original enrollment form and:
- To add a spouse: a copy of your previous year's Federal Tax Return (first page, redacted financial info)
- To add a domestic partner: a copy of your State Registration form (applies to same sex couples only unless one is 62 or older);
- To add your child (adopted, biological, or step): a copy of his/her certified birth certificate and:
YOU MUST ENROLL YOUR NEW DEPENDENT(S) WITHIN 30 DAYS OF THE EVENT (birth, marriage, adoption, etc.) or you may not be able to enroll them until the next regular Open Enrollment Period.
Removing Dependents:
As a reminder, it is the employee’s responsibility to notify the Benefits Coordinator in Human Resources within 60 days of the event if you have a covered dependent that ceases to be your dependent; for example:
- You get divorced.
- Your child between the ages of 19 – 25, gets married or is not a full time student at an accredited institution. (They can remain on Blue Cross or Kaiser, but not dental, vision, the EAP or life insurance). It is your responsibility to notify Human Resources timely.
- Your child becomes an active member of the military.
Failure to timely notify the District (by emailing the Benefits Coordinator in Human Resources) will result in loss of continuation coverage rights under COBRA and may include the carrier(s) billing you for services the ineligible dependent received and/or reimbursement of District paid premiums.
For specific eligibility questions contact the HR Benefits Office at extension 6713 or
HR.Benefits@sjeccd.edu.
Waiving Coverage (for employees or dependents)
Health Insurance Portability & Accountability Act (HIPAA): For those who have declined enrollment for themselves, or any employee who elected to not enroll an eligible dependent (spouse, child, domestic partner) because of enrollment in another health insurance plan, you may be able to enroll yourself and your dependents in a District plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing toward your or your dependents' other coverage) IF you request enrollment within 30 days after your or your dependents' other coverage ends (or after the employer stops contributing toward the other coverage). Failure to notify the Benefits Coordinator timely means you will have to wait until the next regular open enrollment period.
In addition, if you have a new dependent as a result of marriage, birth, adoption or placement for adoption, you may be able to enroll yourself and your dependents. However, you must request enrollment within 30 days after the marriage, birth, adoption, or placement for adoption.
To request special enrollment or obtain more information, contact Michelle McKay, Benefits Coordinator at 408.223.6713 or
HR.Benefits@sjeccd.edu.
Employees are no longer allowed to waive medical coverage for themselves (with the exception of those currently grandfathered in). All employees must at least enroll themselves in Kaiser or Anthem Blue Cross.
Beginning on their 21st birthday and each birth month after that until they turn 23, adult children must be a full-time student at an accredited institution to remain covered by the District's life insurance policy. Before the last day of their birth month, a copy of their current class schedule indicating their total units, or a letter from the school stating their full-time status, and the form below must be submitted to the Human Resources Department or their life insurance coverage will end.
Student Certification Form
If you have an adult child who is disabled, temporarily or permanently, please contact the Benefits staff in Human Resources at extension 6713 to discuss available options of keeping him/her covered UNDER ALL PLANS regardless of age and/or student status. Adult children who become disabled after age 26 and become dependent on you may be eligible for enrollment under the District's health and welfare plans. Please contact
HR.Benefits@sjeccd.edu or call 408.223.6713 immediately for more information and required documentation.
Please note: due to the number of District employees, we are unable to verify the current emergency contact and/or the beneficiary(s) you have on file. If any time during the year you are unsure of who/what you listed, complete a new form(s) and submit the original(s) to Human Resources. All forms above are available all year long on this page and the Human Resources page.
Flexible Spending Account Enrollment/Change Form
Medical Care Reimbursement Account
- The Medical Care Account Maximum is $2,750.00 (the annual minimum is $240.00).
- You will automatically rollover of up to $550 of unused 2021 contributions to be available for you to use in 2022 (even if you do not open an account for 2022).
Medical Care Reimbursement Account Flyer
Dependent Care Reimbursement Account
- The annual maximum for 2021 remains at $5,000.00
This plan allows you to accumulate pre-tax dollars to reimburse yourself for childcare expenses, and/or day care expenses for a disabled dependent while you are employed. Among the eligible expenses are after-school care or extended day programs, babysitters, elder care expenses (if elder is your dependent), preschool and summer day camp.
Dependent Care Reimbursement Account Flyer
Transportation Account
- The maximum MONTHLY election allowed is $270.00
This plan allows you to set pre-taxed dollars aside reimbursement of certain transportation expenses incurred as a direct result of your employment. If you take public transportation (CalTrain, Bart, VTA, etc.).
Transit Plan Overview Flyer
For more information about Flexible Spending Accounts including forms for additional cards, automatic deposit, and the Orthodontia Treatment Statement are available by scrolling down on this page to the Flexible Spending Account section.
IT IS THE PARTICIPANT'S RESPONSIBILITY TO ASSURE THE EXPENSES THEY USE THE PLAN FOR ARE ELIGIBLE EXPENSES AS EACH PLAN HAS STRICT LIMITATIONS ON WHEN ONE CAN CANCEL THE PLAN MID-YEAR.
Medical Care Reimbursement Account Carry Over FAQ
iGOE Orthodontia Treatment Statement
Form for Additional Card (for spouse)
iGOE Direct Deposit Form
Dependent Day Care Provider Acknowledgement
Setting up your Website and iGOE App Account
FSA Carryover Employee Fact Sheet
Optional Forms (see below):
Please refer to Payroll's Public Folder in Outlook for the required forms to enroll in or make changes to a 457 Deferred Compensation Account and for inquires to 403b accounts.
All permanent employees, full and part-time, and adjunct faculty are eligible to enroll in either plan. It does not matter whether you are currently a member of PERS or STRS. It also does not matter what union or constituency group to which you belong.
Plans available to you through your employment with the District (if eligible) are with one of the carriers below:
CalPERS 457 Plan
TIAA CREF
Valic
ALL ENROLLMENT FORMS ARE AVAILABLE THROUGH THE PAYROLL DEPARTMENT, PLEASE CALL THEM AT x6412 OR GO TO THEIR PUBLIC FOLDER IN OUTLOOK.
PERS:
PERS Address Change Form (Complete and Mail to PERS)
PERS Website
PERS Beneficiary Designation Form
STRS:
STRS Address Change Form (Complete and Mail to STRS)
STRS Website
STRS Forms including Beneficiary Designation
The Hartford:
Long Term Disability Insurance:
-
Academic Managers & Full-Time Faculty
-
Classified Managers, Supervisors & Confidential Employees
- CSEA Unit Members
Life Insurance
Basic Life Insurance & Accidental Death and Dismemberment (All)
Hartford Beneficiary Form
Supplemental Life Insurance Brochure (Please contact
HR.Benefits@sjeccd.edu to request an enrollment form)
Personal Health Application
Estate Planning Assistance
Travel Assistance Program
Addition Benefits/Resources from Hartford
To view the PowerPoint presentation on beneficiary designations, purchasing additional life insurance to and other benefits/services The Hartford provides eligible employees (from presentations held onsite April 14, 2015) please click the link below:
Supplemental Life Insurance Workshop, April 2015
VSP Out-of-Network Claim Form
iGOE Flexible Benefit Plan Reimbursement Request Form
Anthem Blue Cross
Kaiser Permanente
Delta Dental
- For All Enrollees (Active & Retired)
Summaries are
not available for medical plans tied to Medicare
